My Scope of Practice: Success in Many Wound Care Hats

Success means having the courage, the determination, and the will to become the person you believe you were meant to be. – George Sheehan

     Don’t let the SAWC Host Committee hats fool you. Carolyn Cuttino, RN, BSN, CWOCN, is an experienced, dedicated, versatile wound care clinician. She attended the Medical University of South Carolina College of Nursing ([MUSC] Charleston, SC) and earned her Bachelor of Nursing degree in 1970. A member of Sigma Theta Tau Society, she began her nursing career as a registered nurse at MUSC, working in Intensive Care, Burn and Trauma, and Staff Development.

She attended Emory University’s (Atlanta, GA) WOCN program in 1977 and became MUSC’s first enterostomal therapist in the 600-bed teaching institution. Carolyn served as a WOCN until her “semi-retirement” in 2002. Today, Carolyn has her own consulting company, Carolina Wound Management Consultants, Charleston, SC. She contracts with nursing homes for staff education and wound management, makes rounds to ensure quality management and proper documentation, and provides expert opinion relative to negligence and malpractice litigation. Carolyn also works part-time at MUSC, handling acute care responsibilities and collaborating with other WOCNs on professional and clinical issues. She also does presentations on wound management. “I like the variety and wide scope of practice I get to experience each day,” she says. “There is no such thing as tunnel vision in the wound care arena.”

     Carolyn asserts that the big picture in wound care is not about any one site of service. Nor is it about any one best product or the best wound care modality. Instead, the big picture is about doing everything possible to promote wound healing and ensure patient comfort and safety at all times. For example, in the acute care setting, the common goal tends toward managing, not necessarily healing, the wound because the patient likely will not be there long. However, Carolyn firmly believes the goal should always be to get the wound as healed as possible before discharge. “There are more resources in the hospital setting than that in long-term care or home care,” Carolyn explains. “We need to utilize these resources before patient discharge and become familiar with the community resources to ensure appropriate follow-up.

     Carolyn currently is involved in a unit that serves patients with healthcare issues who cannot be cared for at home because they have no home, family, funding, or money. Some patients are in this unit for months, even years, awaiting placement and some type of funding so they can be discharged to a residential facility or nursing home. Some patients are content to be discharged to a homeless shelter. Carolyn says barriers to securing care for these persons are the lack of resources, government regulations, and the length of time it takes to obtain assistance from state and federal programs. Carolyn urges clinicians not to be satisfied with the status quo. “As the science of wound care advances, we must advance with it,” she says. She encourages professionals to try new modalities, attend conferences, and stay abreast of new concepts in the literature. Another barrier is a lack of qualified clinicians to care for patients with chronic wounds (because time and effort are wasted). She says there needs to be some governance or criteria met before professionals can hang an outpatient wound care shingle.

     Although Carolyn’s professional responsibilities in the work environment have evolved over the years, many of the patient scenarios remain. “We still see patients with challenging fistulae, pressure ulcers are still developing in all sites of service, our patients with diabetes still present with chronic wounds, and trauma patients still have severe injuries and require demanding care,” she says. “In the good old days when an ostomy patient was not adept at changing his/her pouch, we kept him/her in acute care for an additional day or two. Length of stay in the acute care setting has decreased. Acuity levels have increased in the home and skilled care environment and outpatient wound clinics have filled a need for continued wound management. The new regulations in acute care relative to pressure ulcers are forcing physicians, nurses, and administrators to take notice of what needs to be done to improve patient care. Evidence-based practices with quality outcomes will be the survivors in this new environment.

     Some of the valuable lessons Carolyn’s work has taught her over the years are to always do your best for the patient, treat your staff well, share your knowledge, and exhibit honesty and integrity in every situation. She is honored to know she has made a difference in a life. “Seeing parents of babies that I cared for in the neonatal nursery 20 years ago and hearing about how well the child is doing speaks volumes,” says Carolyn. “They remember mixing karaya and glycerin and they remember that I was there for them and the baby — they remember everything.” She also recalls caring for a terminally ill patient with a poorly placed ostomy stoma who required frequent help at home. The patient’s husband still talks about how valuable Carolyn’s assistance was to them. Another success story involved an up-and-coming WOCN who was attending The Buck Stops Here wound care workshop where Carolyn was presenting for the third time. She said it was Carolyn’s passion for the profession that encouraged her to become a wound care nurse. “Watching the professional growth of nurses I have mentored through the years is probably the best part of my career.

     Family, a good novel, and anything Motown are some of Carolyn’s escapes. Her supportive husband for the past 39 years, Coty was a “Mr. Mom” throughout her early career. “It was challenging to build a career and be the best mom and wife,” Carolyn says. “My husband helped make that possible.” The couple has two children and two beautiful grandchildren.

     Carolyn attended the very first Symposium on Advanced Wound Care (SAWC) in Long Beach, California. “I have missed only one or two meetings since then and that was to have babies,” she says. “The passion among faculty and participants makes you want to be a part of the growing knowledge base surrounding the practice of wound care.”

     After a meeting with the owners of HMP Communications (the SAWC sponsor), talks were initiated about providing regional wound care seminars to healthcare providers who were not able to attend a national conference due to time and money constraints. Carolyn put together the program, HMP assembled corporate sponsors, and The Dermal Wound Management (The Buck Stops Here) regional seminars were born. These seminars have been successful in educating thousands of physicians and nurses for many years.

     Carolyn has chaired the SAWC Host Committee (and encouraged the practice of wearing fun hats) and served on the SAWC Planning Committee for many years. She appreciates that the planning involves healthcare providers from many different specialties. Her passion for the Association for the Advancement of Wound Care (AAWC) arose from the early SAWC meetings. Following a SAWC, a dialogue was initiated that focused on the need to bring the community of wound care practitioners together in a formal setting that could cross-promote the education and caring for patients with wounds. Soon a mission, founding boards, and designated duties were developed for the AAWC.

     In 2009, Carolyn was presented the SAWC Evonne Fowler Founder’s Award, a recognition that spotlights someone whose efforts have contributed to the success of the SAWC and who has furthered the conference’s goal to create a collaborative wound care community. “To receive this prestigious award is the highest peak in my career,” says Carolyn. “It was an exciting and yet a humbling experience to think that my contributions were seen as important as the scientists, physicians, and other nurses who had received the award. I accepted the award on behalf of all the worker bees who will never be famous but who share the founder’s passion for providing quality wound care to all patients.”

     Looking ahead, Carolyn is optimistic about the growth possibilities for the WOCN specialty. “I think the WOCN specialty needs to evolve into an advanced practice nursing degree,” she says. “Many of us now have the knowledge, make the decisions on the ostomy or wound management, and write the order for the MD to co-sign. Although the buck stops with the physician, I believe that advanced practice nurses can improve chronic wound care and help manage patients in more cost-effective ways. Prescriptive authority, reimbursement capabilities, and a higher level of knowledge can strengthen our role in the healthcare arena.”

     Carolyn says that practicing in the present healthcare environment will require more than just clinical skills and expertise. “You need to pay attention to the business side of wound care,” she says. “Many of us have not really appreciated how important it is to stay abreast of federal regulations, payment requirements, and product coding. Moving forward, we all must keep up with what is going on, proliferating determination and innovation, two necessities in our scope of practice.”

This article was not subject to the Ostomy Wound Management peer-review process.